Is the deductible the expense after social security reimbursement?

Deductible is the expenses agreed between the insured and the insurance company, which are within the scope of reimbursement and need to be borne by the insured. Whether the deductible is deducted from the medical insurance reimbursement is subject to the specific product terms insured.

It should be noted that the expenses of social security reimbursement will not be included in the deductible. Only the expenses we bear and the expenses must conform to the contents of this insurance can be included in the deductible. The amount paid with the social security personal account is equal to your own expenses, not social security reimbursement, and can be included in the deductible.

Deductible, as the name implies, is deductible. Refers to the amount that the loss agreed by the insurer and the insured in advance is within the specified amount, and the insured shall bear the loss himself, and the insurer is not responsible for compensation. Generally speaking, only expenses that meet the following two conditions can be included in the insurance deductible: the reimbursement items meet the insurance scope; The expenses are paid by the insured himself.

Because the deductible can eliminate many small claims, it can greatly reduce the cost of claims, reduce the operating costs of insurance companies and reduce the premiums that policyholders need to pay. Therefore, the deductible clause is widely used in property insurance, health insurance and auto insurance.

Deductible refers to the amount of loss that the insured must bear before the insurer pays according to the insurance conditions. Deductible has the following forms:

Absolute deductible

Absolute deductible means that the insured must bear a certain loss before the insurer pays. For example, the absolute deductible stipulated in the contract is 200 yuan, which is lower than the loss of 200 yuan, and the insurer will not compensate.

If the loss exceeds that of 200 yuan, the insurer shall compensate for the excess. Generally speaking, this deductible applies to every loss.

Calculation formula of absolute deductible: insurance claim amount = (total medical expenses-deductible) × payment ratio.

Total deductible

Total deductible. This is to add up all the losses within the scope of insurance liability during the insurance period. If the total loss is lower than the total deductible, the insurance company will not make any compensation.

Once the total loss exceeds the total deductible, the insurance company will pay all the excess losses. In health insurance, the total deductible in a calendar year is often used to accumulate all eligible medical expenses in that calendar year. Once the accumulated amount exceeds a certain amount, the insurer will pay the medical insurance premium according to the contract.

Give citizenship

This is a deductible commonly used in marine insurance. The deductible is expressed as two percentages or a certain amount. If it is lower than the specified proportion or amount, the insurer shall not be liable for compensation; if it is higher than the specified proportion or amount, the insurer shall compensate all the losses.

legal ground

People's Republic of China (PRC) insurance law

Article 17 If an insurance contract is concluded with standard clauses provided by the insurer, the application form provided by the insurer to the applicant shall be accompanied by standard clauses, and the insurer shall explain the contents of the contract to the applicant.

With regard to the clauses in the insurance contract that exempt the insurer from liability, when concluding the contract, the insurer shall make a prompt that can attract the attention of the insured on the application form, insurance policy or other insurance documents, and make a clear explanation to the insured in written or oral form; If there is no prompt or clear explanation, this clause will not take effect.